Chaumont Claire, Bautista-Arredondo Sergio, Calva Juan José, Bahena-González Roberto Isaac, Sánchez-Juárez Gerda Hitz, González de Araujo-Muriel Arturo, Magis-Rodríguez Carlos, Hernández-Ávila Mauricio
Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, México.
Departamento de Enfermedades Infecciosas, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México, Distrito Federal, México.
Salud Publica Mex. 2015;57 Suppl 2:s171-82. doi: 10.21149/spm.v57s2.7606.
This study examines the antiretroviral (ARV) market characteristics for drugs procured and prescribed to Mexico's Social Protection System in Health beneficiaries between 2008 and 2013, and compares them with international data.
Procurement information from the National Center for the Prevention and the Control of HIV/AIDS was analyzed to estimate volumes and prices of key ARV. Annual costs were compared with data from the World Health Organization's Global Price Reporting Mechanism for similar countries. Finally, regimens reported in the ARV Drug Management, Logistics and Surveillance System database were reviewed to identify prescription trends and model ARV expenditures until 2018.
Results show that the first-line ARV market is concentrated among a small number of patented treatments, in which prescription is clinically adequate, but which prices are higher than those paid by similar countries. The current set of legal and structural options available to policy makers to bring prices down is extremely limited.
Different negotiation policies were not successful to decrease ARV high prices in the public health market. The closed list approach had a good impact on prescription quality but was ineffective in reducing prices. The Coordinating Commission for Negotiating the Price of Medicines and other Health Supplies also failed to obtain adequate prices. To maximize purchase efficiency, policy makers should focus on finding long-term legal and political safeguards to counter the high prices imposed by pharmaceutical companies.
本研究考察了2008年至2013年间墨西哥社会卫生保障系统采购和开给受益人的抗逆转录病毒（ARV）药物的市场特征，并将其与国际数据进行比较。
分析了国家预防和控制艾滋病毒/艾滋病中心的采购信息，以估算关键抗逆转录病毒药物的采购量和价格。将年度成本与世界卫生组织全球价格报告机制中类似国家的数据进行比较。最后，对“抗逆转录病毒药物管理、物流和监测系统”数据库中报告的治疗方案进行审查以确定处方趋势，并对2018年前的抗逆转录病毒药物支出进行建模。
结果显示，一线抗逆转录病毒药物市场集中在少数专利治疗药物上，其处方在临床上是适当的，但价格高于类似国家支付的价格。政策制定者目前可用于降低价格的法律和结构性选择极其有限。
不同的谈判政策未能成功降低公共卫生市场抗逆转录病毒药物的高价。封闭式清单方法对处方质量有良好影响，但在降低价格方面无效。药品及其他卫生用品价格谈判协调委员会也未能获得适当的价格。为了使采购效率最大化，政策制定者应专注于寻找长期的法律和政治保障措施，以应对制药公司施加的高价。
